Acknowledgement of ResponsibilityReplacement RecognitionApplication Form

INSTRUCTIONS:

1. Complete this form in full.2. Click the button at the bottom of this completed form to email it to The War Library, along with a copy of your or the veteran's Report of Separation. (Active Duty personnel must provide a printed copy of their online Record Brief) to the address below.

Do Not Hilite, Underline, Circle, ColorizeOr Mark In Any Way The DD-214Or Other Military Document PhotocopyYou Will Be Sending.

Recipient's LAST Name (as it appears on the Report of Separation):
FIRST Name (as it appears on the Report of Separation):

MIDDLE name (as it appears on the Report of Separation):
Title (Must appear on military documentation):Jr
Sr
II
III
IV

Rank Title (Please Do Not Abbreviate):

Paygrade
Enlisted
Warrant
Officer

What was the additional Responsibility assigned to you:

What was the date this additional Responsibility was assigned:

What was the name of your unit or vessel:

What is the name of the Officer, NCO or Supervisor authorizing your additional Responsibility:

REMINDER: Include a photocopy of your DD-214 - AND - a photocopy of the document assigning (or acknowledging) you to perform a special or singular responsibility that did not involve rank/grade increase.

I have not moved. My current address info is on file from a previous application

Address:
City:
State:
ZipCode:
Phone:

Full and complete contact email address:

Please enter the FIRST EIGHT DIGITS ONLY of the Recipient's Service Number:

If you are sending a check or USPS money order please indicate:

I will mail a check along with my application and documentation. The Library will receive my envelope within 10 days from today.

I will mail a USPS money order along with my application and documentation. The Library will receive my envelope within 10 days from today.

CHARGE or DEBIT CARD applicants:

-- My current Card information is already on file from a previous Application

If your Card information is not on file, please Complete the following...

I do not want the Display Recognition. I am requesting the hardwear items listed below (medal, badge, ribbon or patch) if they are available for this award. (Shipping cost applies to non-certificate requests.)

Would you like the full-color Wallet-Size Card Certificate along with one of the above full-size color Certificates (Wallet Cards are available only when a Certificate is requested now or previously.) Yes, Unlaminated ($3.50) Yes, Laminated ($6.00) No
SKIP THIS SECTION IF YOU ARE NOT REQUESTING A CD-ROM...I want Certificates in pdf format on a CD rom...

I want of my Certificates (minimum 20) in full color; $7.50 per Certificate on CD-ROM. I will be emailing a list of the Certificates I want

Would you like an archive (black&white) copy of the Certificate you are applying for to be mailed from the Records Chief directly to your Commanding Officer -or- to your Employer -or- to your School Administrator for inclusion into your permanent personnel file jacket?(Fee: $3.50)

No.

Yes, please mail an embossed, B&W copy of my Certificate to the following person and address:

Yes, please include a PUBLISHED VERSION of the Medal Will for a MALE heir of my Awards and add $4.00 to my total

Yes, please include an EMAILED VERSION Medal Will for a MALE heir of my Awards and add $2.50 to my total

Yes, please include a PUBLISHED VERSION of the Medal Will for a FEMALE heir of my Awards and add $4.00 to my total

Yes, please include an EMAILED VERSION Medal Will for a FEMALE heir of my Awards and add $2.50 to my total

Would you like to track your package through the United States Post Office after it has been shipped (for seventy-five [.75] cents extra)?

Yes, add 75 cents to my total

No, I don't want to track my package

Click Here if you are a Prior Applicant who's DD-214 is on file
New Applicants Click Here

Your Application Form is now complete. After clicking the button below to send this Form you will soon receive a confirmation email containing final instructions on which items, if any, are needed to fulfill your request. Your DD-214 can be mailed or emailed. (Non-personalized items such as hardwear may be exchanged or returned within ten days of delivery. Name-Personalized items such as Certificates that are produced uniquely for a recipient may not be exchanged or returned.)

Records Chief (REC-AMW)The American War Library817 East Via CarmelitosVirginia Building 319Long Beach CA 90805-7549Phone: 1-562-422-4100Policy Statements On Display Recognitions and HardwearPersonalized items shipped or emailed with a name and SN/PSN number cannot be returned or refunded. However, although typographical errors are very rare, there is no time limit on requesting corrections to errors.

Print a copy for yourself before clicking the bar below..

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